Democrats won majorities in both the House and Senate in the Nov. 3 midterm elections, the first time since 2006 that the opposition party has controlled both chambers during a Republican presidency.
The new Congress is sworn in Jan. 3, and for physicians it arrives with a Medicare pay cut already on the books and a healthcare agenda that runs directly into a presidential veto.
Here are nine things to know:
1. The pay cut lands before the new Congress does. Days after the election, CMS finalized the 2027 Medicare physician fee schedule, which cuts the conversion factor for most physicians by 2.31%, from $33.40 to $32.63, starting Jan. 1. The final cut is deeper than the 1.68% CMS proposed, and it lands as the one-time 2.5% increase Congress approved for 2026 expires Dec. 31. Physicians in qualifying alternative payment models face a smaller 1.83% reduction.
2. Any fix before Jan. 1 depends on the outgoing Congress. Relief would have to come from the Republican-led Congress during a lame-duck session expected to focus on government funding and expiring health programs. Preventing the physician cuts is a bipartisan priority, but movement is a long shot, KFF Health News reported Nov. 4 in a story published by CBS News. Physician groups immediately turned to Capitol Hill anyway.
“Congress must intervene to prevent further harm by immediately fixing cuts to the conversion factor,” Anders Gilberg, senior vice president of government affairs at MGMA, said, according to Becker’s.
The American College of Physicians is pushing for a longer-term answer.
“We need a permanent payment fix that will stabilize Medicare physician payments and protect access to care,” ACP President Jan Carney, MD, said in a Nov. 5 statement.
3. Coverage tops Democrats’ agenda, and payer mix is the stake for practices. Party leaders have put restoring the enhanced ACA premium subsidies that expired at the end of 2025, and reversing the Medicaid cuts in HR 1, at the top of the list. The Congressional Budget Office estimates the law cuts about $911 billion in federal Medicaid spending from 2025 to 2034, and KFF projects 7.5 million more people will be uninsured, The American Journal of Managed Care reported Nov. 6. Medicaid work requirements begin Jan. 1 in most states.
Dev GnanaDev, MD, chairman of the department of surgery at Arrowhead Regional Medical Center in Colton, Calif., told Becker’s that eliminating the Medicaid cuts and restoring the subsidies would ease the financial strain on low- and lower-middle-income patients.
4. The veto limits what becomes law. President Donald Trump keeps his veto, and HR 1 is one of his signature legislative wins. He has sent mixed signals about how widely he’ll use it, telling Politico, according to KFF Health News:
“I don’t want to just be sitting there for two years vetoing everything.”
Others are skeptical. Larry Levitt, executive vice president of KFF, said passing Democrats’ full agenda “will be impossible with President Trump still in the White House.” David Brueggeman, a managing director at Berkeley Research Group, told AJMC that providers “shouldn’t really plan on relief coming from Washington.”
5. Oversight is where Democrats have the most leverage, and the targets overlap with physician complaints. Democrats are expected to examine insurer prior authorization denials, Medicare Advantage and the use of AI in coverage decisions. Sen. Ron Wyden, D-Ore., the ranking member expected to retake the Senate Finance Committee gavel, said in a Nov. 4 statement that insurers “will be forced to answer to the Senate Finance Committee” once he is chair.
6. Physicians are split on consolidation and site-neutral payment. Krista Edelman, MD, a gastroenterologist and partner at Richmond (Va.) Gastroenterology Associates, told Becker’s she hopes the election brings more scrutiny of healthcare consolidation, renewed attention to site-neutral payment and policies that support independent physician ownership. Dr. GnanaDev expects less movement. He told Becker’s that Democrats are unlikely to embrace site-neutral payments because they view hospitals’ EMTALA obligations as justifying higher reimbursement.
7. More physicians are headed to Congress, and the party balance among them has flipped. About 20 physicians will serve in the 120th Congress, and for the first time in decades, Democrats outnumber Republicans among them, according to the American College of Gastroenterology. Pediatrician Annie Andrews, MD, D-S.C., and Abdul El-Sayed, MD, D-Mich., will be the first Democrats with medical degrees in the Senate since 1969, Becker’s ASC reported, citing STAT. The Senate is also losing two Republican physicians: Sen. Roger Marshall, MD, R-Kan., lost his reelection bid, and Sen. Bill Cassidy, MD, R-La., chair of the Senate health committee, is leaving after losing his primary.
8. Workforce and telehealth bills are already queued up. ACG is backing the Resident Physician Shortage Act, which would add Medicare-funded residency slots, and the CONNECT for Health Act, which would make Medicare telehealth coverage permanent.
9.Some leaders expect a divided government to produce more conflict than law.
“I think the biggest issue coming out of this election is going to be constant conflict and nothing getting done because there is no willingness to compromise,” John Goehle, COO of Rochester, N.Y.-based Ambulatory Healthcare Strategies, told Becker’s.
CMS will keep advancing regulations regardless of who controls Congress. For physicians watching the Jan. 1 cut take effect, the request to lawmakers remains the same.
“I’d like Congress to give practices a predictable payment update that reflects what it actually costs to care for patients,” Shakeel Ahmed, MD, founder and CEO of St. Louis-based Atlas Surgical Group, told Becker’s.
At the Becker’s 32nd Annual Meeting: The Business and Operations of ASCs, taking place October 29-31 in Chicago, ASC leaders, surgeons and healthcare executives will explore strategies to drive growth, enhance operational performance, navigate reimbursement challenges and prepare for the future of ambulatory surgery. Apply for complimentary registration now.
